RARE MANIFESTATIONS OF HYDROXYZINE OVERDOSE INDUCED ARDS AND DISTRIBUTIVE SHOCK

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Hydroxyzine primarily treats pruritus, anxiety, and insomnia due to its ability bind histaminic, muscarinic, serotonergic, dopaminergic receptors. Here, we present a case of rare manifestations hydroxyzine overdose. CASE PRESENTATION: A 30-year-old female presented after suicidal attempt with presumptive amlodipine She was found tachycardic, tachypnic, hypotensive, lethargic. Urine serum drug screen negative. Blood gas revealed non-anion gap metabolic acidosis. Chest x-ray (CXR) showed no anomalies. ECG sinus tachycardia normal QT interval. head CT Crystalloid fluid resuscitation initiated for overdose induced hypotension. Norepinephrine (NE) drip distributive shock. Day 1, she complained excessive thirst urinary retention; CXR bilateral diffuse infiltrates. Echocardiogram left ventricular ejection fraction 60-65% without wall motion abnormalities or valvulopathy. 2, developed delirium visual hallucination, warm dry, intermittent hypotension, large A-a gradient, PaO2/FiO2 ratio <100, worsening infiltrates on CXR; consistent severe ARDS requiring intubation. Clinical presentation suspicious anticholinergic toxicity. External records 120-tablet 25 mg prescription, the family provided an update revealing empty bottle 90 tabs 25mg at home. There role hemodialysis hemoperfusion. required maximal support NE, vasopressin, phenylephrine, dopamine Due persistent symptomatology, two trials physostigmine were administered transient avail. 3, ventilator hypoxemia referred ECMO. 4, slowly weaned off dopamine, phenylephrine NE prior transfer ECMO facility. After transfer, extubated, discharged home initiation DISCUSSION: In young adults, has 20-hour half life. Our patient ingested about 2 grams hydroxyzine. The diagnosis toxicity may be confirmed by resolution improvement symptoms during slow IV injection 0.5 1 salicylate. General supportive care seizure control diazepam result in complete recovery within 72 hours. CONCLUSIONS: is safe effective drug, but life-threatening adverse effects can occur Symptoms are delirium, seizures, tachycardia, High dose cause postmortem analysis demonstrated pulmonary edema, hyperemia occasional alveolar hemorrhage. REFERENCE #1: Iain M. Phyllis Amber T. Jacquelyn distribution cases potential redistribution. Forensic Science International 231 (2013) 28-33. https://doi.org/10.1016/j.forsciint.2013.04.013 #2: Alshahrani MSS, Attalla M, Perri D, Klimaszyk D. Anticholinergic Syndrome (Anticholinergic Toxicity). McMaster Textbook Internal Medicine. Kraków: Medycyna Praktyczna. https://empendium.com/mcmtextbook/chapter/B31.II.20.11. Accessed March 31, 2021. #3: Sonia L. Kristen Spencer G. James Manpreet V. Gwen E. Extracorporeal Cardiopulmonary Resuscitation Diphenhydramine Ingestion. Journal Toxicology (2018) 14:253-256. http://doi.org/10.1007/s13181-018-0672-6 DISCLOSURES: No relevant relationships Alex Morizio, source=Web Response Tram Nguyen, Elena Tellez, Yaswanraj Yuvaraj,